Rescue services activation

ABSTRACT

A system for providing remote assistance to a caregiver during a medical event includes a computer tablet with a transmitter/receiver to communicably couple the tablet with a remote computing system associated with central caregivers, physiological sensors for collecting patient information, and a defibrillator configured to couple to the sensors and including a transmitter/receiver to communicably couple the defibrillator and tablet, and a processor to receive the patient information from the sensors, provide the patient information for display, and communicate the patient information to the tablet, the tablet being configured to generate a user alert for communications with the remote system based on a signal indicating that resuscitative treatment of the victim is being administered, the signal including the patient information received from the sensors, and the user alert including a request for a confirmation to initiate communications with the remote system, and, in response, establish communications with the remote system.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit under 35 U.S.C. § 120 as acontinuation of U.S. patent application Ser. No. 16/178,917, filed Nov.2, 2018, which is a continuation of U.S. patent application Ser. No.15/456,818, filed Mar. 13, 2017 and abandoned, which is a continuationof U.S. patent application Ser. No. 13/538,006, filed on Jun. 29, 2012and issued as U.S. Pat. No. 9,628,946. All subject matter set forth ineach of the above referenced applications is hereby incorporated byreference in their entirety into the present application as if fully setforth herein.

TECHNICAL FIELD

This document relates to systems and techniques for coordinatingemergency medical response with lifesaving activities of a firstresponder such as CPR and defibrillation.

BACKGROUND

Sudden health problems such as sudden cardiac arrest and injuries causedby accidents kill thousands of people and cause permanent injury everyyear. Fast and competent care to resuscitate such victims of theseproblems can be essential to positive outcomes in such situations. Forexample, it is said that the chance of surviving a sudden cardiac arrestfalls by ten percent for every minute of delay in providing effectivetreatment.

Resuscitation treatments for patients suffering from cardiac arrestgenerally include clearing and opening the patient's airway, providingrescue breathing for the patient, and applying chest compressions toprovide blood flow to the victim's heart, brain, and other vital organs.If the patient has a shockable heart rhythm (ventricular fibrillation orpulseless ventricular tachycardia), resuscitation also may includedefibrillation therapy. Along with such action, an electrocardiogram(ECG) signal for the patient may be electronically captured, displayed,and monitored, so that rescuers can determine when the patient's hearthas returned to normal or near-normal operation, and determine when theheart exhibits a shockable rhythm. About half of patients who sufferventricular fibrillation (VF) have a recurrence of VF within minutes ofsuccessful VF conversion, which may then require reconversion. Patientodds of survival fall with repeated VF recurrence during resuscitation.

SUMMARY

This document describes systems and techniques for coordinatingemergency medical response with lifesaving activities of a firstresponder such as CPR and defibrillation. In some aspects, in thesystems and methods described herein, upon initialization of the AEDuser input is required prior to the placement of a call to emergencymedical services. In contrast to methods in which the AED automaticallyalerts emergency medical services each time the AED is initialized,requiring the user input is believed to reduce the number of falsepositives in which emergency medical services would otherwise be alertedwhen an emergency does not exist.

In some aspects, an automated external defibrillator system includes adevice configured to detect initialization of the automated externaldefibrillator, a communication unit, and a processing unit. Theprocessing unit is configured to receive a signal from the deviceconfigured to detect initialization indicating initialization of theautomated external defibrillator, in response to the received signal,generate a prompt requesting user input about whether rescue servicesshould be alerted, process a response from the user, and based on apositive response from the user, send a signal to cause thecommunication unit to form an audio communication channel between theautomated external defibrillator and rescue services.

Embodiments can include one or more of the following.

The device configured to detect initialization can be a sensor.

The sensor can be a light sensor configured to detect whendefibrillation pads are removed from a package.

The processing unit can be further configured to access locationinformation associated with the automated external defibrillator systemand automatically provide the location information to the rescueservices based on the accessed location information.

The configurations to process a response from a user can includeconfigurations to use speech recognition to process an audio responsereceived from the user.

The configurations to process a response from a user can includeconfigurations to detect a response inputted by the user on a userinterface.

The rescue services can include an emergency response center.

The system can also include a timer unit configured to track elapsedtime subsequent to generating the prompt.

The configurations to process the response from the user can includeconfigurations to process an inputted response from the user or a lackof response from a user and the configurations to send a signal to thecommunication unit based on a positive response further compriseconfigurations to send a signal to the communications unit to cause thecommunication unit to form an audio communication channel between theautomated external defibrillator and rescue services based on the lackof response from the user and the track elapsed time.

The communication channel can be a telephonic communication channel.

The communication channel can be a communication channel establishedover a 3G or 4G communication network.

In some additional aspect, a method can include detecting initializationof an automated external defibrillator, in response to detecting theinitialization of the automated external defibrillator, generating aprompt requesting user input about whether rescue services should bealerted, processing a response from the user, and based on a positiveresponse from the user, sending a signal to cause the communication unitto form an audio communication channel between the automated externaldefibrillator and rescue services.

Embodiments can include one or more of the following.

Detecting initialization of an automated external defibrillator caninclude receiving a signal from a sensor in the automated externaldefibrillator and processing the received signal.

Receiving the signal from a sensor can include receiving the signal froma light sensor configured to detect when defibrillation pads are removedfrom a package.

The method can also include accessing location information associatedwith the automated external defibrillator system and automaticallyproviding the location information to the rescue services based on theaccessed location information.

Processing the response from the user can include using speechrecognition to process an audio response received from the user.

Processing the response from the user can include detecting a responseinputted by the user on a user interface.

In some additional aspects, a computer program product tangibly embodiedin a computer readable medium can include instructions to cause acomputing device to receive a signal from the device configured todetect initialization indicating initialization of the automatedexternal defibrillator, in response to the received signal, generate aprompt requesting user input about whether rescue services should bealerted, process a response from the user, and based on a positiveresponse from the user, send a signal to cause the communication unit toform an audio communication channel between the automated externaldefibrillator and rescue services.

In some aspects, an automated external defibrillator system includes asensor configured to detect initialization of the automated externaldefibrillator, a cellular communication unit; and a processing unit. Theprocessing unit is configured to receive a signal from the sensorindicating initialization of the automated external defibrillator and inresponse to the received signal, generate an audio prompt requestinguser input about whether rescue services should be alerted. Theprocessing unit is further configured to receive an audio input from auser in response to the generated audio prompt, use speech recognitiontechnology to process the received response from the user, and based ona positive response from the user, send a signal to cause the cellularcommunication unit to form a communication channel between the AED andan emergency services call center. The processing unit is furtherconfigured to access location information associated with the AED systemand automatically provide location information to an emergency servicescall center based on the accessed location information associated withthe AED system.

The details of one or more embodiments are set forth in the accompanyingdrawings and the description below. Other features and advantages willbe apparent from the description and drawings, and from the claims.

DESCRIPTION OF THE FIGURES

FIG. 1A is an overhead view of rescuers performing CPR on a victim usingan electronic system that instructs them in performance of the CPR.

FIG. 1B is a view of a serviceman performing service on the electronicsystem FIG. 1A.

FIG. 2 shows an example system, in schematic form, for coordinatingtreatment of a victim.

FIG. 3 is a flow chart of an example process for initiating acommunication with emergency medical services.

FIGS. 4A and 4B show example systems in schematic form.

FIG. 5 is a flow chart of an example process for initiating acommunication with emergency medical services.

FIG. 6 is a flow chart of an example process for initiating acommunication with emergency medical services.

DETAILED DESCRIPTION

This document describes mechanisms for coordinating emergency medicalresponse with lifesaving activities of a responder such as CPR anddefibrillation by generating a communication with an emergency medicalresponse unit (e.g., an ambulance dispatch, EMT responders, emergencyservices call centers). Methods and systems for determining when anautomated external defibrillator (AED) device is initialized and seekinginput from an individual near the device regarding whether rescueservices should be called is described herein. Thus, in some exampleswhen user input is a pre-requisite for initiating the communication,rescue service units are only called upon confirmation from the userthat assistance is needed. This is believed to reduce the false positiverate for calls to the emergency medical services.

FIG. 1 is an overhead view of a rescuer 104 performing CPR on a victim102 using an electronic system (e.g., an AED 108) that automaticallydiagnoses cardiac arrhythmias such as ventricular fibrillation andventricular tachycardia and is able to treat them throughdefibrillation. The AED 108 also instructs the rescuer in performance ofthe CPR. In this example, rescuer 104 is in position and providing careto the victim 102. The rescuer 104 may be a lay rescuer who was in thevicinity of the victim 102 when the victim 102 required care, or may betrained medical personnel, such as emergency medical technicians (EMTs).

During a rescue, there are multiple different tasks that require therescuer's attention and time. Good quality compressions with little orno pausing (e.g., substantially continuous administration ofcompressions) are important for cardiac arrest survival. Additionally,it is important to request trained medical help as soon as possible tobe able to quickly provide more extensive medical care than can beprovided by the rescuer at the scene of the emergency. In order toassist the rescuer with multitasking and balancing performance of themultiple tasks, the AED 108 includes a communications unit forinitiating contact with the emergency rescue services. Moreparticularly, when the AED 108 is initialized (e.g., removed from box,turn on, or otherwise enabled) the AED 108 asks the rescuer whetheremergency medical services should be alerted. As shown in FIG. 1A, theAED 108 is equipped with a speaker which outputs an audio message askingthe rescuer “is this an emergency for which emergency medical servicesshould be alerted?” (as shown in block 120). In an emergency situation,as shown in FIG. 1A, the rescuer can then respond by simply saying “yes”(as shown in block 122), and the AED 108 automatically places a call tothe emergency medical services (e.g., a 911 call center) requesting thatan emergency medical team be dispatched to the location of the AED 108.In contrast, in a non-emergency situation, as shown in FIG. 1B, therescuer can respond by saying “no” and the AED 108 will not place a callto emergency medical services. For example, when the AED 108 is beingserviced the AED 108 is likely to be initialized but there is no needfor emergency medical services to be alerted.

Thus, user input is required prior to placing a call to emergencymedical services. In contrast to methods in which the AED automaticallyalerts emergency medical services each time the AED 108 is initialized,requiring the user input is believed to reduce the number of falsepositives in which emergency medical services would otherwise be alertedwhen an emergency does not exist. Further, the system automaticallyrequests the input at a predetermined time (e.g., at deviceinitialization) to reduce the delay in calling rescue services shouldthey be needed.

FIG. 2 shows an example system in schematic form, for providing CPR anddefibrillation assistance to a rescuer and for alerting emergencyservices to the need for assistance. In general, the system involves anumber of medical devices (including a defibrillation unit 212 that isable to treat them through defibrillation) that may be used to providelife-saving care to a victim, such as a victim 202, of sudden cardiacarrest. The various devices may be part of a single unit or multipleunits, and may be used to monitor various real-time physical parametersof the victim 202, to communicate between the components and with remotesystems such as central caregivers and emergency services, and toprovide care to the victim 202 or provide instructions to caregivers,such as caregiver 204, in providing care to the victim 202.

The victim 202 in this example is an individual who has apparentlyundergone sudden cardiac arrest and is being treated by the caregiver204. The caregiver 204 may be, for example, a civilian responder who hashad limited training in lifesaving techniques, an emergency medicaltechnician (EMT), a physician, or another medical professional. Thecaregiver 204 in this example may be acting alone or may be acting withassistance from one or more other caregivers, such as a partner EMT.

The victim 202 is in a position in which therapy has been provided tothe victim 202. For example, a set of defibrillator electrodes 210 havebeen applied to the victim's torso in a typical manner and are in wiredconnection to a portable defibrillation unit 212 that includes an energyoutput device 208. The defibrillation unit 212 may be, for example, anautomated external defibrillator (AED), a professional defibrillator, orother similar type of defibrillating apparatus. The victim 202 can alsobeen provided with a ventilation bag (not shown) to provide forced airinto the victim's lungs to assist in rescue breathing of the victim 202.The defibrillation unit 212 and ventilation bag may be operated infamiliar manners and in coordination by various caregivers. Also, theventilation bag may be fitted with various sensors and transmitters soas to communicate electronically with the defibrillation unit 212. Forexample, a volumetric flow sensor may be provided with the ventilationbag, and data about the volume of airflow to and from the victim may bepassed to defibrillation unit 212, so the defibrillation unit 212 mayrelay such information, or may also use such information to affect themanner in which defibrillation is provided to the victim 202.

A computer tablet 214 is also shown communicating with thedefibrillation unit 212 and other devices. The tablet 214 may serve as ageneral electronic command post for the caregiver 204 to receiveinformation about the victim 202 and other items, to communicate withother caregivers, and to provide input in controlling the operation ofthe various components in the system. The tablet 214 may be providedwith short range and long range wireless communication capabilities,such as Bluetooth® or WiFi on the one hand, and cellular 3G or 4G on theother. The caregiver 204 may input information into the tablet computer214, such as information describing the condition of the victim 202 andother similar information that is to be recognized and recorded by thecaregiver 204. The tablet 214 may also be in data communication withmultiple sensors for sensing real-time information about the victim 202,such as blood pressure, pulse, and similar real-time patient parameters.The caregiver 204 may also input information into tablet 214 so as tocontrol one or more of the medical devices being used with the victim202. For example, the user may adjust the type, intensity, speed, orcoordination of treatment that is provided to the victim 202.

The defibrillation unit 212 also includes a communication module 237.The communication module 237 includes a transmitter and receiver forproviding communication links between the defibrillation unit 212 andemergency services 243 (e.g., a 911 call center, a police dispatch, anambulance dispatch, a fire department, etc.). For example, thecommunication module 237 can include short range and long range wirelesscommunication capabilities, such as Bluetooth or WiFi on the one hand,and cellular 3G or 4G on the other. During use, the communication module237 can send a signal to a cellular tower 241 which in turn can relaythe signal to emergency services 243. Further, emergency services 243may communicate directly with a rescuer, for example, throughcommunication module 237. Thus, bidirectional communication isestablished between the defibrillation unit 212 and emergency services243. While shown in FIG. 2 as being included in defibrillation unit 212,the communication module could additionally or alternatively be includedin the tablet 214.

Defibrillation unit 212 also includes initialization detector 239. Theinitialization detector 239 is in communication with sensors or otherdevices in the unit in order to determine when the unit has been turnedon or otherwise initialized. For example, the initialization unit candetermine when a cover of the unit is opened and upon determining thatthe cover has been opened, cause the unit to alert the caregiver 204 tothe opportunity to initiate a call to emergency services 243. Thecaregiver can be alerted by speaker 236 a and/or by informationdisplayed on computer tablet 214. Only upon receipt of appropriateconfirmation from the caregiver 204 does the communication module 237establish a communication channel to the emergency services 243.

A Chest Compression Unit (CCU) 216 is one of the medical devices thatmay be provided for administering to the victim 202, either integratedphysically with other devices or in a separate self-contained unit. Inone implementation, the CCU 216 delivers the chest compressions via aload distributing band that is placed around a patient's upper thorax.The CCU 216 may take the form, for example, of the AUTOPULSEnon-invasive cardiac support pump from ZOLL Medical Corporation ofChelmsford, Mass. Such a device may be used to constrict the victim'schest evenly and thereby provide improved blood flow in the victim 202.

Various components within defibrillation unit 212 may be employed toprovide dynamically adjusted and potentially synchronized chestcompressions with the CCU 216, where the compressions are coordinated intime with ECG waveforms and communicated to CCU 216.

A CCU 216 may not be available in certain situations, so that chestcompressions 218 may also be delivered manually by the caregiver 204. Insuch a case, audiovisual feedback can be provided to the caregiver 204via speaker 236 a and display 224. Such feedback can direct thecaregiver 204 to deliver compressions less forcefully when necessary, orat different speeds. It may also otherwise instruct the caregiver in theprovision of care to the victim.

As shown in this example, multiple different input signals are receivedthat characterize the current real-time condition or physical parametersof the victim 202. For example, an ECG signal 222 may be received by thedefibrillation unit 212 and may represent current and real time ECGwaveforms for the victim 202, which may be obtained by leads connectedto defibrillation unit 212.

An SpO₂ signal 223, or other physiologically-derived signal that iseither a direct or indirect measure of circulatory flow or perfusion, isalso captured at box 224, and may be used to further determine when andat what force to apply chest compressions to the victim 202.

Although FIG. 2 shows specific examples of input signals such as SpO₂,an apparatus could use any relevant combination of physiological signalssuch as, but not limited to: ECG, measures of cardiac output, measuresof heart rate, blood pressure(s), oxygen saturation (SpO₂), heart sounds(including phonocardiography), heart imaging (including ultrasound), andimpedance cardiography. Compression parameters could use any relevantcombination of features or measurements of compression including, butnot limited to: compression velocity; compression depth; duty cycle;velocity of downstroke and upstroke; intrathoracic pressures duringcompressions; pleural pressures during compressions; sternal position,velocity or acceleration; chest wall or sternal strain or deformation;force applied to the chest; and pressure used to compress the chest by amechanical chest compressor.

A sternal motion signal 226 is also sensed as an input to thedefibrillation unit 212, such as to provide a feedback loop to determinethe level of chest compression that has been provided to the victim 202.In particular, the defibrillation unit 212 may continue to supply acompression signal to the CCU 216 until feedback from the sternal motionsignal 226 indicates that the compressions have achieved a particulardegree of movement in the sternum (e.g., two inches of vertical motion).

The feedback based on the sternal motion signal 226 may also be used tofeed back the amount of downstroke or upstroke velocity that a caregivershould be delivering so as to minimize the risk of inducingfibrillation. The feedback may be in the form of verbal prompts, e.g.“Release more slowly”, or a visual indicator via the display 224 (seeFIG. 7 ) where the bar above the word “Release” will fill in proportionto the upstroke velocity of each compression delivered by the rescuer,but will turn red if the upstroke velocity is determined to be in excessof a limit above which the risk of induction of fibrillation isdetermined to be excessive. The goal of the rescuer is thus to maximizethe filled portion of the “Release” bar without having it turn red. Acoordinated combination of audible and visual feedback may also beprovided.

A signal processing unit 228 is provided to filter inputs, such as ECGinputs, received from the patient for further analysis by themicroprocessor 230. For example, the signal processing unit 228 mayfilter noise from input signals, and in the case of ECG data may filterartifacts created by chest compression motion of the victim 202 in orderto remove such artifacts. Such preparation of ECG signals may be termedSEE-THRU CPR, and can be performed as discussed in U.S. Pat. No.7,220,235, the teachings of which are incorporated herein by referencein their entirety.

A calculation may be performed using characteristics of the ECG, inparticular the ST portion of the ECG waveform. For instance, STelevation is indicative of ischemic injury and likely elevatedsensitivity to compression-induced initiation of fibrillation. Based onthe measurement of ST characteristics or other parameters of the ECG,the maximum safe thresholds for parameters of the compression—e.g.upstroke or downstroke velocity—can be calculated. The process fordetermining the maximum safe thresholds may also take into account statevariables like numbers of shocks delivered, the amount of current orenergy delivered for the immediately previous shock, a total amount ofcumulative energy or current delivered for all shocks, particularmorphological characteristics of the ECG such as T wave amplitude andinversion, QRS duration, and R wave curvature or sharpness.

Based on either retrospective data analysis of clinical data sets thatinclude simultaneous recording of sternal motion signals and ECGs aswell as patient outcome data, or of pre-clinical testing in animalmodels, a statistical model may have been developed that can predict therisk of fibrillation induction. The statistical model may in turn beused to determine an appropriate compression profile to be provided to apatient, and to be aligned in time with ECG data of the patient. Thestatistical model may be in the form of either a linear or non-linearregression equation, using such techniques as multiple logisticregression.

There may be multiple inputs to the regression equation, such ascompression depth, upstroke and downstroke velocity, and the timing ofeach of the compression phases relative to the T-wave, as well asresuscitation information like defibrillation energy, number of shocks,etc., or ECG information such as ST elevation, T-wave amplitude etc. asmentioned above, thus forming an input vector. The regression equationwill thus form a matrix calculation, where the input vector, X, is a 1×ndimensional matrix where n is the number of input variables, and theregression transformation matrix is an n×n matrix. The output vector, Y,is a 1×n matrix where each element is the probability that particularparameter will induce fibrillation.

The input matrix may only incorporate ECG, other physiological signalslike SpO2, or other perfusion measure and resuscitation informationelements, to form a 1× p matrix with p elements, a transformation matrixof dimension p×q, where q are the number of compression parameters to beoptimized, e.g. upstroke and downstroke velocity at-depth duration, etc.Based on the a priori-derived statistics and a theoretical model of theeffect of compression parameters on blood flow, optimal control methodsknown to those skilled in the art may be employed, such as Hamiltoniancontrol theory as introduced by Pontryagin or as an alternative, Gauss,Radau, or Lobatto pseudospectral optimal control, to achieve maximumblood flow while minimizing risk of fibrillation induction.

The theoretical model of the effect of compression parameters on bloodflow may be a mathematical description of the circulatory system, suchas that described in Crit. Care Med 2000 Vol. 28, No. 11 (Suppl.). Asthat article describes, a system of differential equations has beendescribed in a number of publications. In the specific instance of thearticle, “the human circulation is represented by seven compliantchambers, connected by resistances through which blood may flow. Thecompliances correspond to the thoracic aorta, abdominal aorta, superiorvena cava and right heart, abdominal and lower extremity veins, carotidarteries, and jugular veins. In addition, the chest compartment containsa pump representing the pulmonary vascular and left heart compliances.This pump may be configured to function either as a heart-like cardiacpump, in which applied pressure squeezes blood from the heart itselfthrough the aortic valve, or as a global thoracic pressure pump, inwhich applied pressure squeezes blood from the pulmonary vascular bed,through the left heart, and into the periphery. Values for physiologicvariables describing a textbook normal “70-kg man” are used to specifycompliances and resistances in the model. The distribution of vascularconductances (1/resistances) into cranial, thoracic, and caudalcomponents reflects textbook distributions of cardiac output to variousbody regions.” The input to the model is then the real time sternalmotion waveform during chest compressions.

A microprocessor/analyzer 230 is provided to receive input informationregarding the real-time parameters of the patient, including ECGwaveform data, and to perform analysis on such data to cause, anddynamically adjust, compressions and decompressions to be executed byCCU 216 or to modify the feedback prompts provided on the display 224and annunciated by the speaker 236 a. In this example, the coordinationis between (a) an ECG waveform, (b) optional shocking by thedefibrillator energy output 208, and (c) provision of signals to the CCU216 to cause the CCU 216 to actuate in coordination with the ECG in themanners discussed above and below. Thus, for example, the defibrillationunit 212 may receive the ECG signal 222, may monitor the ECG signal todetermine the rate of repetition of the signal (i.e., the patient'scardiac cycle) and the current location in the signal, and may use suchinformation to compute the time boundaries for the next vulnerableperiod. Using such boundaries, the microprocessor/analyzer 230,executing stored software code, may compute a compression profile to beapplied to the victim 202 so that compression/decompression motion ofthe CCU 216 is avoided during the vulnerable periods for the victim 202,and/or so that the velocity of motion is decreased in the period soonafter a shock has been provided, and increased at a time farther afterthe shock has been provided, and closer to the time before a next shockis to be provided.

Triggering circuits may be signaled by the defibrillation unit 212 atappropriate times so as to generate the signals needed to cause the CCU216 to squeeze and release the victim 202. Sternal motion signals 226may be captured during such a process so that the defibrillation unit212 can determine the level of compression or decompression that hasbeen achieved, and can adjust the signals sent to the CCU 216accordingly, using familiar closed loop control techniques.

The process carried out by the defibrillation unit 212, then, may be acontinuous and cyclic process in which ECG data flows into thedefibrillation unit 212 and is processed so that a continuous series ofchest compressions may be provided to the victim 202 and coordinatedwith shocks from the defibrillator energy output 208 until the caregiver204 intervenes (e.g., by changing certain parameters or by ending theprocess, such as when the victim 202 has restored his or her normal orsustainable heart rhythm). Particular ones of the chest compressions maydiffer from particular other ones in their compression profiles,including in the relative timing of the start of a compression ordecompression, the rate of the compression or decompression, the lengthof hold times between compressions and decompressions, and in theoverall length of a compression cycle.

The chest compression actions and/or other actions taken with respect tothe victim 202 may also be taken manually and may be prompted by thevarious devices, including the defibrillation unit 212. Each of thechanges in compression profile discussed above may also be prompted viasuch a manual process. For example, coordinated chest compression timesand rates may be computed by the microprocessor/analyzer and may beverbally announced by the audio processor/speaker unit 236 a and 236 bin familiar manners. For example, a metronome of beeping sounds may beplayed to indicate to the caregiver 204 during CPR when to press down onthe victim's 202 chest so as to avoid compressions or decompressionsduring a vulnerable period. Also, a display 224 may provide coordinatedvisual feedback, such as by showing an ECG waveform, showing a graph ofcompression depth for the victim 202, and showing other similar datathat may be helpful in aiding the caregiver 204 in providing for thevictim 202.

FIG. 3 is a flowchart of an example process for initiating acommunication with emergency services 243 upon receipt of a request fromthe rescuer to initiate such services. In general, the processautomatically prompts the user for input based on measured signalindicating that the defibrillation unit 212 is in use and requires aresponse from the user prior to initiating communication with emergencyservices group 243.

The process begins at box 302 where one or more inputs of thedefibrillation device 212 are monitored over a period of time. Theseinputs continue to be monitored until the defibrillation device 212determines that it has been initialized at box 304. For example, thedefibrillation device 212 can include a sensor such as initializationdetector 239 that provides a signal when a cover to the defibrillationdevice is opened indicating that the device is in use. In anotherexample, the defibrillation unit 212 can include the light sensor suchthat when defibrillation pads are opened and removed from theirpackaging, light is sensed by the light sensor to provide a signalindicating that the device is in use. In another example, thedefibrillation unit 212 can include a power switch and when the powerswitch is pressed, the signal can be sent indicating that the device isin use.

At box 306, upon determining that the defibrillation unit 212 has beeninitialized, the device automatically prompts the rescuer (e.g.,caregiver 204) for a decision regarding whether rescue services shouldbe alerted. At block 308, the defibrillation unit 212 receives aresponse to the request from the rescuer. For example, thedefibrillation unit 212 can include a user interface or display and thedisplay can include a ‘yes’ and ‘no’ button which the user can depressto indicate whether emergency services should be alerted. In anotherexample, the device can include a speaker 236 a and a microphone. Thespeaker can be used to provide an audio message asking the rescuerwhether emergency services should be alerted and the microphone can beused to receive a verbal response from the rescuer. Signal processingand voice recognition can be used to determine whether the rescuerprovided a positive or negative response.

At box 310, the defibrillation unit 212 determines whether the responsewas positive or negative for the need to alert medical services. If theresponse was that the emergency services did not need to be alerted,then the defibrillation unit 212 exits and does not initiatecommunication with emergency services 243 at box 312. On the other hand,if the response was that emergency services needed to be alerted, thenthe defibrillation unit 212 initiates a communication with emergencyservices 243 at box 314. The defibrillation unit 212 can additionallyprovide location information to the emergency services 243 based on thelocation of the defibrillation unit 212 at box 316. For example, aregistry can include location information for the defibrillation devicesand when a particular defibrillation device initiates the communicationwith emergency services unit, the location information for thatparticular defibrillation device can be accessed in the database andprovided to the emergency services unit. In other examples, thedefibrillation device can be equipped with a GPS tracking unit and alocation determined by the GPS tracking can be provided to the emergencyservices unit. In some additional examples, the defibrillation devicecan include a memory that stores location information for the device andthe stored information can be provided to the emergency services unit.

Referring now to FIG. 4A, FIG. 4A shows a block diagram of thecommunications between the rescuer 404, the AED device 416, andemergency medical services 420. The AED device 416 includes a microphone406, a speaker 410, and audio processing module 408, a signal processingmodule 412, and a transmitter/receiver 414.

During use, the signal processing unit 412 determines when the AEDdevice 416 is initialized. Upon initialization, the signal processingmodule 412 provides an output to cause speaker 410 to produce an audiomessage to the rescuer 404. The message asks the rescuer 404 whether anemergency exists for which rescue services should be alerted, forexample, whether an emergency exists for which emergency services shouldbe called. In response to the audio message from speaker 410, rescuer404 can verbally indicate whether emergency rescue services should becalled. This response is received by microphone 406 and audio processingunit 408 determines whether the response was positive or negative. Forexample, speech recognition can be used to determine whether the rescuer404 has indicated that emergency services should be called. If theresponse indicates that emergency services should be called, the signalprocessing unit 412 provides a signal to the transmitter/receiver 414 tocause the transmitter/receiver to initiate the communication channelwith a cellular tower 418 and in turn with the emergency medicalservices 420.

Referring now to FIG. 4B, FIG. 4B shows a block diagram ofcommunications between a rescuer 424, an AED device 432, and emergencymedical services 436. The AED device 432 includes a user interface 426,a signal processing unit 428, and a transmitter/receiver 430.

During use, the signal processing unit 428 determines when the AEDdevice 432 is initialized. Upon initialization, the signal processingmodule 428 provides an output to cause the user interface 426 to displaya message to the rescuer 424. Message to the rescuer 424 can ask therescuer 424 whether an emergency exists for which rescue services shouldbe alerted. The rescuer 424 can provide a response via the userinterface 426 and/or via other input buttons on the AED device 432. Ifthe response indicates that emergency services should be called, thesignal processing unit 428 provides a signal to the transmitter/receiver432 cause the transmitter/receiver 432 initiate the communicationchannel with an emergency medical services group 436 for example via acellular connection using a cellular tower 434.

FIG. 5 is a flowchart of an example process for initiating acommunication with emergency services upon receipt of a request from therescuer to initiate such services and/or in the absence of a responsefrom the rescuer that emergency services should not be called. Ingeneral, the system prompts the user for input and wait for a responsefrom the user prior to initiating communication with an emergencyservices group. However, if no response is received from the rescuer(e.g., the rescuer may be attending to other functions of the rescue andnot provide a response), then the emergency services are notified due tothe absence of the response from the rescuer.

The process begins at box 502 where one or more inputs of thedefibrillation device are monitored over a period of time. These inputscontinue to be monitored until the device determines that it has beeninitialized at box 504 (e.g., as described herein). For example, thedefibrillation device can include a sensor that provides a signal when acover to the defibrillation device is opened thus indicating that thedevice is in use.

At box 506, upon determining that the defibrillation device has beeninitialized, the device prompts the rescuer for confirmation of whetherrescue services should be alerted. At block 508, the system initializesa timer to track elapsed time since the prompt was provided to therescuer. At block 510, the system waits for either a response from therescuer or for the timer to reach a threshold amount of time. Forexample, the timer can count down from a set amount of time and/or thecounter can count up from zero and determine when a threshold amount oftime has elapsed. Upon determining that either a response has beenreceived from the rescuer or the threshold amount of time has elapsed,at block 512, the system determines whether a responses was received. Ifa response has not been received, i.e., the threshold amount of time haselapsed, then the AED device automatically initiates communication withthe emergency services at block 514. On the other hand, if the systemdetermines their response was received from the rescuer, at block 516the system determines whether the response was positive or negative forthe need to alert medical services. If the response was that theemergency services did not need to be alerted, then the system exits anddoes not initiate communication with emergency services at box 518. Onthe other hand, if the response was that emergency services did need tobe alerted, then the system initiates a communication with emergencyservices at box 520.

FIG. 6 is a flowchart of an example process for initiating acommunication with emergency services upon receipt of a request from therescuer to initiate such services. In general, the process prompts theuser for input and requires a response from the user prior to initiatingcommunication with emergency services group. In the example shown inFIG. 6 , if the rescuer initially responds that emergency services donot need to be alerted but continues to perform a rescue operation, thesystem can later provide another opportunity for the rescuer to initiatecommunication with emergency services by prompting the rescuer secondtime during administration of CPR.

The process begins at box 602 where one or more inputs of thedefibrillation device are monitored over a period of time. These inputscontinue to be monitored until the device determines that it has beeninitialized at box 604 (e.g., as described herein). At box 606, upondetermining that the defibrillation device has been initialized, thedevice prompts the rescuer for confirmation of whether rescue servicesshould be alerted. At block 608, the system receives a response to therequest from the rescuer. For example, the device can include a userinterface or display in the display can include ‘yes’ and ‘no’ buttonwhich the user can depress to indicate whether emergency services shouldbe alerted. In another example, the device can include a speaker and amicrophone. The speaker can be used to provide an audio signal askingthe rescuer whether emergency services should be alerted and themicrophone can be used to receive a verbal response from the rescuer.Signal processing and voice recognition can be used to determine whetherthe rescuer provided a positive or negative response to the request. Atbox 610, the system determines whether the response was positive ornegative for the need to alert medical services. If the response wasthat emergency services did need to be alerted, then the systeminitiates a communication with emergency services at box 314. On theother hand, at block 612, if the response was that emergency servicesdid not need to be alerted, the system does not initiate thecommunication with emergency services.

Thus, user input is required prior to placing a call to emergencymedical services. In contrast to methods in which the AED automaticallyalerts emergency medical services each time the AED 108 is initialized,requiring the user input is believed to reduce the number of falsepositives in which emergency medical services would otherwise be alertedwhen an emergency does not exist. At block 616, the system continues tomonitor inputs to the AED device. For example, the system can monitorECG inputs and/or accelerometer inputs to determine whether the systemhas been attached to a victim and/or whether CPR is being administered.At block 618, the system initializes the timer and waits for apredetermined length of time. After the predetermined length of time haselapsed, at block 620 the system determines whether rescue services arebeing performed. For example, the system can determine based on themonitored inputs whether CPR is being administered. If rescue servicesare not being performed, at block 622 the system exits from the process.On the other hand, if the system determines based on the monitor inputsthat rescue services are being performed, at block 624 the systemprompts the rescuer for confirmation of whether rescue services shouldbe alerted and initiates a communication with the rescue services if therescuer indicates that such services are desired.

The features described can be implemented in digital electroniccircuitry, or in computer hardware, firmware, software, or incombinations of them. The apparatus can be implemented in a computerprogram product tangibly embodied in an information carrier, e.g., in amachine-readable storage device, for execution by a programmableprocessor; and method steps can be performed by a programmable processorexecuting a program of instructions to perform functions of thedescribed implementations by operating on input data and generatingoutput. The described features can be implemented advantageously in oneor more computer programs that are executable on a programmable systemincluding at least one programmable processor coupled to receive dataand instructions from, and to transmit data and instructions to, a datastorage system, at least one input device, and at least one outputdevice. A computer program is a set of instructions that can be used,directly or indirectly, in a computer to perform a certain activity orbring about a certain result. A computer program can be written in anyform of programming language, including compiled or interpretedlanguages, and it can be deployed in any form, including as astand-alone program or as a module, component, subroutine, or other unitsuitable for use in a computing environment.

Suitable processors for the execution of a program of instructionsinclude, by way of example, both general and special purposemicroprocessors, and the sole processor or one of multiple processors ofany kind of computer. Generally, a processor will receive instructionsand data from a read-only memory or a random access memory or both. Theessential elements of a computer are a processor for executinginstructions and one or more memories for storing instructions and data.Generally, a computer will also include, or be operatively coupled tocommunicate with, one or more mass storage devices for storing datafiles; such devices include magnetic disks, such as internal hard disksand removable disks; magneto-optical disks; and optical disks. Storagedevices suitable for tangibly embodying computer program instructionsand data include all forms of non-volatile memory, including by way ofexample semiconductor memory devices, such as EPROM, EEPROM, and flashmemory devices; magnetic disks such as internal hard disks and removabledisks; magneto-optical disks; and CD-ROM and DVD-ROM disks. Theprocessor and the memory can be supplemented by, or incorporated in,ASICs (application-specific integrated circuits).

To provide for interaction with a user, the features can be implementedon a computer having a display device such as a CRT (cathode ray tube)or LCD (liquid crystal display) monitor for displaying information tothe user and a keyboard and a pointing device such as a mouse or atrackball by which the user can provide input to the computer.

The features can be implemented in a computer system that includes aback-end component, such as a data server, or that includes a middlewarecomponent, such as an application server or an Internet server, or thatincludes a front-end component, such as a client computer having agraphical user interface or an Internet browser, or any combination ofthem. The components of the system can be connected by any form ormedium of digital data communication such as a communication network.Examples of communication networks include, e.g., a LAN, a WAN, and thecomputers and networks forming the Internet.

The computer system can include clients and servers. A client and serverare generally remote from each other and typically interact through anetwork, such as the described one. The relationship of client andserver arises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.

The computer system may include software for implementing an electronicpatient care record, for example the ePCR software of ZOLL® Data Systems(Broomfield Colo.). The software provides the ability to enter, storeand transmit patient information as well as therapeutic interactions.The computer is often a so-called “tablet” computer system that has beenruggedized for pre-hospital use, but may also take the form of aniPhone® or iPad®. Data is preferably transmitted in real time betweenthe portable “tablet” computer to a defibrillation unit 212, such asdata that indicates the delivery of epinephrine to a victim. Asepinephrine may increase risk of VF induction, notification of itsdelivery may be used by the microprocessor/analyzer 230 to adjust thecompression parameters to further minimize risk of VF induction. Otherseparate treatments provided to the patient, or parameters of thepatient condition sensed by the various sensors may also be provided tothe tablet, and may factor into the rate, timing, force, or speed withwhich compressions and decompressions are performed on the patient.

A number of embodiments have been described. Nevertheless, it will beunderstood that various modifications may be made without departing fromthe spirit and scope of the invention. Accordingly, other embodimentsare within the scope of the following claims.

What is claimed is:
 1. A system for providing to a caregiver remoteassistance with resuscitative treatment of a patient during a medicalevent, the system comprising: a computer tablet located at a scene ofthe medical event, the computer tablet comprising: a firstcommunications module comprising a first transmitter/receiver configuredto communicably couple the computer tablet bi-directionally with aremote computing system associated with central caregivers, a firstprocessor and first memory, and a first display; one or morephysiological sensors configured to collect patient information; and adefibrillator configured to couple to the one or more physiologicalsensors, the defibrillator comprising: a second communications modulecomprising a second transmitter/receiver and configured to communicablycouple the defibrillator bi-directionally with the computer tablet, asecond display, a second processor and a second memory, the secondprocessor configured to: receive the patient information from the one ormore physiological sensors, provide the patient information at thesecond display, and communicate the patient information to the computertablet, wherein the computer tablet is configured to: generate an alertfor a user of the computer tablet for communications with the remotecomputing system in response to a signal received at the computer tabletfrom the defibrillator indicating that the resuscitative treatment ofthe patient with the defibrillator is underway, wherein the signalcomprises the patient information received by the defibrillator from theone or more physiological sensors, and wherein the user alert comprisesa request for user confirmation that communications should be initiatedwith the remote computing system, and in response to the userconfirmation, establish a bi-directional communication channel with theremote computing system via the first communications module.
 2. Thesystem of claim 1, wherein the defibrillator and the computer tablet areconfigured to communicably couple with one another via a WiFi orBluetooth® communications link.
 3. The system of claim 1, wherein thecomputer tablet is configured to display the patient information fromthe one or more physiological sensors in real-time.
 4. The system ofclaim 3, wherein the patient information comprises blood pressure,pulse, oxygen saturation, and heart rate.
 5. The system of claim 3,wherein the patient information comprises ultrasound images.
 6. Thesystem of claim 3, wherein the patient information comprises an ECGwaveform.
 7. The system of claim 3, wherein the one or morephysiological sensors comprise a sternal motion sensor and the patientinformation comprises chest compression feedback based on a signal fromthe sternal motion sensor.
 8. The system of claim 7, wherein the chestcompression feedback comprises a bar shaped graphic elementcorresponding to release.
 9. The system of claim 7, wherein the chestcompression feedback comprises an indication of an indirect measure ofperfusion.
 10. The system of claim 7, wherein the chest compressionfeedback comprises least one of chest compression depth feedback andchest compression rate feedback.
 11. The system of claim 7, wherein atleast one of the defibrillator and the computer tablet comprises aspeaker configured to provide the chest compression feedback as audiblecaregiver prompts.
 12. The system of claim 11, wherein the audiblecaregiver prompts comprise a metronome.
 13. The system of claim 7,wherein the defibrillator is configured to perform compression waveformanalysis on the signal from the sternal motion sensor.
 14. The system ofclaim 13, wherein the at least one of the defibrillator and the computertablet is configured to modify the chest compression feedback based onthe compression waveform analysis.
 15. The system of claim 1, whereinthe one or more physiological sensors comprise a flow sensor configuredto provide airflow data to the defibrillator and the patient informationcomprises the airflow data.
 16. The system of claim 15, wherein the flowsensor is provided with a ventilation bag.
 17. The system of claim 1,wherein the computer tablet is configured to receive user inputcomprising a description of a condition of the patient and an operationof the defibrillator, a chest compression unit, and/or another medicaldevice used with the patient.
 18. The system of claim 1, wherein thecomputer tablet is in data communication with the one or morephysiological sensors.
 19. The system of claim 1, wherein thebi-directional communication channel comprises one or more of a WiFicommunications link and a cellular communications link.
 20. The systemof claim 19, wherein the bi-directional communication channel enables aprovision of treatment assistance instructions to the caregiver fortreatment of the patient during the medical event.